Healthcare Provider Details

I. General information

NPI: 1740115864
Provider Name (Legal Business Name): SADIE SEBASTIAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SADIE BOLTON APRN

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 STATE ST
BISMARCK ND
58503-0669
US

IV. Provider business mailing address

2700 STATE ST
BISMARCK ND
58503-0669
US

V. Phone/Fax

Practice location:
  • Phone: 701-712-4501
  • Fax:
Mailing address:
  • Phone: 701-712-4501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number205291
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: